Before initiating biologic DMARD therapy in rheumatoid arthritis, which vaccine is recommended?

Administering the shingles vaccine is recommended before starting biologic DMARD therapy in rheumatoid arthritis because biologic agents can significantly suppress the immune system, increasing the risk of infections, including viral infections such as shingles (herpes zoster). The shingles vaccine, specifically the recombinant zoster vaccine (Shingrix), can help prevent this complication.

With the onset of therapy that modulates the immune response, taking preventive measures such as vaccination is crucial to reducing the likelihood of infectious complications. It is generally advisable to administer live vaccines before starting immunosuppressive therapy, and since the zoster vaccine is preventive in nature, it is particularly important to do so in patients who may develop shingles due to decreased immunity.

In typical practice, other vaccines may also be considered, but the shingles vaccine is especially emphasized in this context due to the specific risks associated with biologic therapy.